Efficacy, Safety, and Tolerability of Once-Daily Niacin for the Treatment of Dyslipidemia Associated With Type 2 Diabetes<subtitle>Results of the Assessment of Diabetes Control and Evaluation of the Efficacy of Niaspan Trial</subtitle>

Abstract

Low doses of ER niacin (1000 or 1500 mg/d) are a treatment option for dyslipidemia in patients with type 2 diabetes.

Utilization patterns of extended-release niacin in Canada: Analysis of an administrative claims database

“…Furthermore, ERN was associated with similar patterns in antihyper glycemic agent use in T2DM patients compared with other LMDs, which are not generally associated with changes in glycemic control. These results are consistent with those of clinical trials, which did not witness any significant changes in the use of insulin and antihyperglycemic agents (27) or HbA1c (27,28) in patients treated with niacin.…”

“…In most ERN patients (n=737; 85.0%), treatment was initiated at a daily dose of 500 mg or less, leading to the (4) 21 (6) 123 (4) 116 (5) Cardiologist 245 (28) 1696 (9) 26 (8) 116 (3) 48 (2) Endocrinologist 47 (5) 444 (2) 24 (7) 98 (3) 47 (2) Other 17 (2) 915 (5) 18 (5) 124 (4) highest rates of persistence. A minority of patients (n=18) initiated treatment at the highest daily doses (1000 mg to 1500 mg) and did not persist with therapy beyond 60 to 180 days ( Figure 2).…”

“…However, these data involved treatment using high-dose (greater than 4000 g/day) niacin, which is generally not recommended in clinical practice. Other clinical trials have shown that patients treated with lower daily doses of niacin (1 g to 2.5 g of IRN formulation) showed no significant changes in the use of insulin and antihyperglycemic agents (27), and no clinically relevant changes in HbA1c (IRN or ERN formulation) (27,28). However, there is relatively little information concerning changes in glycemic control and associated changes in resource utilization among T2DM patients treated with ERN in regular clinical practice.…”

A “Hot” Topic in Dyslipidemia Management—“How to Beat a Flush”: Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention

“…Studies summarized in eTable 1 [65][66][67][68][69][70][71][72][73] (available online, linked to this article) evaluated the effects of niacin monotherapy on surrogate (lipid or lipoprotein) end points and patient-related flushing per se (ie, flush provocation studies). In 1 long-term study, more than 40% of patients using extended-release niacin experienced flushing at treatment week 4 compared with less than 20% at week 96.…”

“…In a meta-analysis 74 of HDL-C-raising therapies involving more than 4000 patients using immediate-release niacin (n=3062), 75-83 sustained-release niacin (n=536), 66,67,77,[84][85][86] or extended-release niacin (n=648), [68][69][70][71]87,88 some of the results of which are summarized in eTable 1, most patients (70%) receiving niacin experienced flushing (vs 4% with placebo; P<.001). This proportion included 85% of patients receiving immediate-release niacin, 66% receiving extended-release niacin, and 26% receiving sustained-release niacin.…”